How it develops
Normally, the lower esophageal sphincter holds the contents of the stomach. If it does not close tightly, acid and bile regularly enter the esophagus and damage the mucous membrane. Over the years, existing inflammation causes the tissue to be rebuilt: instead of a multilayered squamous epithelium, a cylindrical epithelium appears with goblet cells characteristic of the intestines. Such metaplasia resists acid better, and often heartburn even weakens, creating a false impression of improvement. Further changes in cells are called dysplasia, and it is its degree that determines the risk and monitoring tactics.
- The basis is long-term reflux of stomach contents
- Replacing squamous epithelium with intestinal epithelium
- Heartburn may decrease, but the process continues
- The next stage is low and high degree dysplasia
- Risk of developing esophageal adenocarcinoma
Who's at risk
The condition is most often diagnosed in men over fifty years of age with heartburn lasting more than five years. The risk is increased by being overweight with fat deposits in the abdominal area, smoking, hiatal hernia and heredity - cases of Barrett's esophagus or esophageal cancer in close relatives. Habits play a role: large meals at night, strong alcohol, frequent consumption of very hot food. At the same time, in some patients, metaplasia is found by chance, without significant heartburn, because reflux can be hidden.
- Heartburn longer than 5 years
- Male gender and age over 50 years
- Obesity, especially abdominal obesity
- Smoking
- Hiatal hernia
- Cases of illness in relatives
How to identify
The only way to make a diagnosis is gastroscopy. The doctor sees the characteristic tongues of reddish mucosa rising above the junction of the esophagus and the stomach, measures their length and necessarily takes a biopsy from several points according to a certain pattern. The final conclusion is made by the morphologist: the diagnosis is confirmed only when intestinal metaplasia is detected and an indication of whether there is dysplasia and to what extent. For better visualization, examination in special modes and chromoendoscopy are used. Before a planned gastroscopy, the doctor may ask you to adjust your intake of acid-reducing medications.
- Gastroscopy with examination of the transition zone
- Biopsy according to the standard scheme
- Histological conclusion about metaplasia and dysplasia
- Inspection in special optical modes
- Estimation of the length of the modified section
Observation
Regular control gastroscopy is the basis of tactics, because they make it possible to detect changes at a stage when treatment is less traumatic and effective. The interval is determined by the doctor depending on the extent of the area and the presence of dysplasia: if it is absent, the examination is usually repeated every few years, with low-grade dysplasia - much more often, with high-grade dysplasia, the issue of endoscopic treatment is decided. It is important to be observed in one institution and to save protocols and histological reports: comparison with previous results gives the doctor more information than one recent description.
- Planned gastroscopy with biopsy
- The interval depends on the degree of change
- Store all protocols and histology
- See one specialist
- Don't miss deadlines
Treatment
The basis is constant control of reflux. Proton pump inhibitors are prescribed, often long-term, because they reduce mucosal damage. Non-drug measures are no less important: losing weight, quitting smoking and strong alcohol, having your last meal three hours before bedtime, raising the head of the bed, avoiding tight clothing and overeating. For high-grade dysplasia and early cancer, endoscopic methods are used: removal of the altered area of the mucosa and radiofrequency ablation. Surgical operation on the esophageal opening of the diaphragm is discussed when therapy is ineffective and there is a severe hernia.
- Long-term proton pump inhibitors, as prescribed by a doctor
- Weight loss
- Quitting smoking and strong alcohol
- Do not eat 3 hours before bedtime, raise the head of the bed
- Endoscopic removal of areas with dysplasia
- Radiofrequency ablation
- Antireflux surgery according to indications
